Adjusted Activity Score Research Articles

Short physical performance battery in aerobic capacity and physical activity evaluation of individuals with peripheral artery disease: An exploratory study

BackgroundPeripheral artery disease (PAD) negatively affects functional ability. Persons with PAD experience gait limitation, and changes in mobility, muscle strength, and balance. Assessing individuals with PAD with tests of lower limb performance during activities other than walking may provide information about aerobic capacity. ObjectiveTo evaluate whether the Short Physical Performance Battery (SPPB) can discriminate aerobic capacity and level of physical activity in individuals with PAD. MethodsThe SPPB, Incremental Shuttle Walking Test (ISWT), and the Human Activity Profile (HAP) were completed by 42 volunteers with PAD. The sample was stratified into tertiles by the distance walked in the ISWT and the Adjusted Activity Score (AAS) of HAP. One-way analysis of variance with a post-hoc least significant difference was used to compare the SPPB values between tertiles of ISWT and AAS of HAP. P-value < 0.05 was considered significant. ResultsThe mean age was 65 ± 7.7 years, the walking distance was 259.29 ± 115.28 m, and AAS of HAP was 68.36 ± 9.04. There was a significant difference in the total SPPB score and scores for gait speed and sit-to-stand for groups stratified by ISWT and AAS of HAP(p = 0.01). The balance domain was different only for groups stratified into tertiles by AAS of HAP(p = 0.04). ConclusionThe results of this study have clinical relevance for the evaluation of individuals with PAD at different aerobic and physical activity levels. The SPPB is a viable alternative in the practice of the specialty of vascular nursing and other areas of health to assess patients whose ability to perform walking tests is often limited.

Upper extremity functions and physical activity in chronic maintenance hemodialysis patients: A case-control study.

Continuous hemodialysis (HD) treatment causes many complications in patients. The aim of this study is to evaluate the upper extremity functional capacity, physical activity level, and physical functions of patients receiving continuous HD treatment. Fifty HD patients and fifty healthy subjects were included in the study. Hand grip strength with Dynamometer, range of motion of upper extremity with Digital Goniometer, functional level of the upper extremity with the Turkish version of the Shoulder, Arm, and Hand Problems Questionnaire (The DASH-T), physical activity levels with international physical activity questionnaire short form and physical functions with the human activity profile (HAP) were evaluated. The mean grip strength of the subjects in the control group was 23.3 ± 1.44 kg, while the mean grip strength of the HD patients with fistula was 15.75 ± 3.08 kg (P < .05). In all joint range of motion measurements; the values of HD patients were significantly lower than the control group (P < .05). The DASH symptom scores of the individuals in the HD group (mean 19.19 ± 1.41) were significantly higher than the control group (mean 5.75 ± 1.41) (P < .05). The number of individuals with low-level activity in the HD group (72%) was higher than the control group (34%) (P < .01). The maximum activity score score of the HAP (mean 68.7 ± 1.4) and the adjusted activity score of the HAP (mean 42.54 ± 3.02) were lower in the HD group (P < .0001). HD treatment adversely affects hand grip strength, the range of motion, upper extremity functions, physical activity, and physical function levels of the patients.

#4416 MAINTAINING PHYSICAL ACTIVITY IN PATIENTS THROUGH INTRADIALYTIC VIRTUAL REALITY EXERCISE INTERVENTION: THE REVID STUDY

Abstract Background and Aims People suffering from Chronic kidney disease (CKD) have lower levels of physical activity than their healthy counterparts. The lower level of physical activity is associated with impaired physical function in people undertaking hemodialysis. The COVID-19 pandemic has worsened the physical activity level of this cohort. Intradialysis exercise programs have a positive impact on many functional variables, but despite these proven benefits exercise interventions are scarce in clinical practice. Our group is implementing strategies to increase clinical applicability of exercise programs. Virtual reality (VR) intradialysis programs improve function of patients. The main aim of this study was to analyze the impact of an intradialytic non-immersive VR exercise program on physical activity level of people undertaking hemodialysis treatment. Methods A randomized trial (the REVID study) included two groups of patients, exercising at different times during the dialysis session for up to 12 months. The present study includes participants from the REVID study who, once the study finished, continued exercising at their preferred time during the hemodialysis treatment, with the only support of the health professionals at the HD unit. Adherence to the exercise program was measured as a percentage (number of sessions attended divided by the number of sessions offered). The physical activity level was evaluated using the Human Activity Profile (HAP) questionnaire. The HAP scale is self-administered and a list of 94 daily activities; the maximal activity score (MAS) and adjusted activity score (AAS) were calculated in this evaluation. Depending on the outcome of the HAP, patients were classified as having physical activity levels that were “impaired” (&amp;lt;53 points), “moderately active” (53–74 points), or “active” (&amp;gt;74 points). These patients had been exercising The intradialytic exercise consisted of a non-immersive VR game called ‘Treasure Hunt’ in which the participant try to catch targets and avoid obstacles by moving their lower limbs (hip flexion, abduction and adduction, and knee flexion and extension). The difficulty level of the game was graduated according to the characteristics of each player and the patients were allowed to change their legs during the game at their convenience. The impact of the program on physical activity level was analyzed with a non-parametric test for paired simples (p&amp;lt;0.05). Results This study included 11 participants, mean age 71.6 (13.9) years, 9 males, median dialysis vintage 18 months (10 to 50 interquartile range), and Charlson index 6.3 (2.2). The AAS at the baseline of the REVID study was 66 (58-72 interquartile range). The median time that participants exercised in the REVID study was 12 months (6 to 18 months interquartile range). After 3 months of the present study, when they exercised at any time during dialysis, they maintained their physical activity level, from a median AAS of 69 (interquartile range 52-71), to a Median of 70 (interquartile range 41-74). The changes were non-significant. The mean adherence to the exercise sessions was 54.6 (11.7)%. Conclusion This study suggests that an intradialysis virtual reality exercise program maintains the physical activity level of elderly patients undertaking HD. Most of the participants in this long-term intervention were male and moderately active. Future interventions should include an ‘exercise champion’ professional in the units to recruit women and les conditioned participants, and to achive higher adherence rates.

MO835: Physical Activity Measured by Pedometer And Human Activity Profile in Hemodialysis Patients

Abstract BACKGROUND AND AIMS Physical inactivity is associated with increased mortality in hemodialysis patients and the level is still unclear. Several studies have surveyed physical activity in hemodialysis patients with subjective methods by questionnaires, and some have used objective methods based on accelerometers or pedometers in small population. This study aimed to investigate the level of physical activity of hemodialysis patients with a combination of pedometer and questionnaire and explore the influencing factors limiting the physical activity. METHOD A multi-center cross-sectional survey using pedometer and Human Activity Profile (HAP) was performed in 505 hemodialysis patients. The pedometer (Omron, HJ-321) measured daily steps by continuously wearing for a week. HAP can provide a maximum activity score (MAS) reflecting the most taxing activity the patient is still doing, and an adjusted activity score (AAS) reflecting the level of daily activity. Linear regression was performed to explore factors related to the physical activity. RESULTS A total of 505 patients were included in this study. The average age (means ± SE) was 49.69 ± 13.96 years with 141 (27.92%) patients were elderly (≥60 years old), and 339 (67.13%) were male. Patients walked 4585.84 ± 2887.40 steps/day, 94.65% of patients had physical activity levels below the guideline recommended level (10 000 steps/day), and 60% were in sedentary lifestyle (&amp;lt;5000 steps/day). The AAS score was 63.85 ± 13.99, 112 patients were impaired (&amp;lt;53 points), and 275 were moderately active (≥53 and &amp;lt;74 points). The univariate linear regression showed that the elderly, unemployed, diabetic nephropathy and patients with diabetes or &amp;gt;3 complications had fewer steps and lower MAS and AAS scores (P &amp;lt; 0.05). Besides, the number of steps in patients undergoing hemodialysis 5 times every 2 weeks was significantly lower than that of patients 3 times/week (P = 0.020). And for MAS and AAS, the ability to perform daily activities was significantly impaired in females and patients over 36 months of hemodialysis (P &amp;lt; 0.05). In multivariate linear regression, elderly patients with &amp;gt;3 complications were associated with lower levels of physical activity (P &amp;lt; 0.05). Females [–2.72 (–5.21 to –0.24); P = 0.032] with hypertension [6.14 (1.89–10.40); P = 0.005), congestive heart failure [5.24 (0.94–9.53); P = 0.017] and ischemic heart disease [6.48 (1.01–11.94); P = 0.020] were more likely to have impaired daily physical activity. CONCLUSION This survey demonstrates that hemodialysis patients are engage in physical inactivity. Elderly hemodialysis patients with more complications are prone to physical inactivity. Patients undergoing hemodialysis 5 times every 2 weeks are more likely to be live with sedentary lifestyle, while female patients with hypertension, congestive heart failure and ischemic heart disease are more impaired in daily physical activity. We should pay attention to the physical inactivity of hemodialysis patients.

MO880: Clinical Characteristics Associated With Human Activity Profile Scores in Hemodialysis Patients With Thyroid Dysfunction: A Substudy of the NIH THYROID-HD Trial

Abstract BACKGROUND AND AIMS Low physical activity is common in hemodialysis (HD) patients and is associated with adverse outcomes in this population (poor health-related quality of life, cardiovascular [CV] disease, death). Prior studies show that hypothyroidism is highly prevalent in HD patients, and is associated with worse self-reported physical function. METHOD In a substudy of the ongoing multi-center NIH THYROID-HD Trial, we examined baseline physical activity scores determined by the Human Activity Profile (HAP), a validated 94-item instrument assessing daily activities across a wide range of energy expenditures, in HD patients with TSH levels in the high-normal (TSH &amp;gt;3–5 mIU/L) and subclinical hypothyroid range (TSH &amp;gt;5–10 mIU/L). The HAP was used to derive the Maximum Activity Score (MAS) and Adjusted Activity Score (AAS), representing greatest and mean estimated energy expenditures, respectively (range 0–94, segmented to low [&amp;lt;52], moderate [54–73] and high [&amp;gt;74] scores). RESULTS Among 100 HD patients who underwent baseline HAP assessment, the mean ± SD MAS and AAS scores were 48 ± 22 and 23 ± 27, respectively; median (IQR) MAS and AAS scores were 49 (31–64) and 9 (0–39), respectively (Figure 1). In the overall cohort, 83% had low, 10% moderate and 7% high AAS scores. MAS and AAS scores were significantly lower in patients who had underlying diabetes versus those without diabetes (Table 1). There was also a trend towards lower (worse) MAS and AAS scores among older versus younger patients (≥65 versus &amp;gt;65 years, respectively) and patients with underlying coronary artery disease (CAD) versus those without CAD. In logistic regression analyses, older age (+∆ 1-year increments) was associated with higher likelihood of low MAS scores, and diabetes trended towards a significant association (defined as &amp;lt; median of observed values) (ref: MAS ≥ median): ORs [95% confidence intervals (95% CIs)]: 1.04 (1.01–1.09); P = 0.005 and 2.57 (0.96–6.86); P = 0.06, respectively. Similarly, older age (+∆ 1-year increments) and diabetes were each associated with higher likelihood of low AAS scores (defined as &amp;lt; 52) (ref: moderate-high AAS scores): ORs (95% CIs): 1.06 (1.02–1.11); P = 0.01 and 4.83 (14.6–16.0); P = 0.01, respectively. CONCLUSION In this substudy of the NIH THYROID-HD Trial, HAP scores in HD patients with high-normal and subclinical hypothyroid range TSH levels were lower than observed in prior historical dialysis cohorts that did not have underlying thyroid dysfunction. Additionally, older age and diabetes were each associated with worse HAP scores. Further research is needed to determine the impact of thyroid hormone replacement on improving physical activity and function in this population, particularly those of elder age and with underlying diabetes.

Assessment of V̇o2peak and Exercise Capacity After Stroke: A Validity Study of the Human Activity Profile Questionnaire

ObjectiveTo investigate the concurrent validity of the Human Activity Profile (HAP) in individuals after stroke to provide the peak oxygen uptake (V̇o2peak) and the construct validity of the HAP to assess exercise capacity, and to provide equations based on the HAP outcomes to estimate the distance covered in the Incremental Shuttle Walking Test (ISWT). DesignCross-sectional study. SettingUniversity laboratory. ParticipantsIndividuals (N=57) aged 54±11 years who have experienced stroke. InterventionNot applicable. Main Outcome MeasuresAgreement between the V̇o2peak provided by the HAP (lifestyle energy consumption [LEC] outcome, in mL/kg−1/min−1) and the criterion standard measure of the V̇o2peak (mL/kg−1/min−1), obtained through the symptom-limited Cardiopulmonary Exercise Test (CPET). Correlation between the HAP outcomes (LEC, maximum activity score [MAS], and adjusted activity score [AAS]) and the construct measure: the distance covered (in meters) in the ISWT. An equation to estimate the distance covered in the ISWT was determined. ResultsHigh magnitude agreement was found between the V̇o2peak, in mL/kg−1/min−1, obtained by the symptom-limited CPET and the value of V̇o2peak, in mL/kg−1/min−1, provided by the HAP (LEC) (intraclass correlation coefficient, 0.75; P<.001). Low to moderate magnitude correlations were found between the distance covered in the ISWT and the HAP (LEC/MAS/AAS) (0.34≤ρ≤0.58). The equation to estimate the distance covered in the ISWT explained 31% of the variability of the ISWT (ISWTestimated, –361.91+(9.646xAAS)). ConclusionThe HAP questionnaire is a clinically applicable way to provide a valid value of V̇o2peak (in mL/kg−1/min−1) and to assess the exercise capacity of individuals after stroke. Furthermore, an equation to estimate the distance covered in the submaximal field exercise test (ISWT) based on the result of the AAS (in points) was provided.

Nonrelapse mortality among patients diagnosed with chronic GVHD: an updated analysis from the Chronic GVHD Consortium

AbstractChronic graft-versus-host disease (cGVHD) is the leading cause of late morbidity and mortality after allogeneic hematopoietic cell transplantation. To better understand patients at highest risk for nonrelapse mortality (NRM), we analyzed patient-, transplant-, and cGVHD-related variables, risk factors, and causes of nonrelapse deaths in an updated cohort of 937 patients enrolled on 2 prospective, longitudinal observational studies through the Chronic GVHD Consortium. The median follow-up of survivors was 4 years (range, 0.1 months to 12.5 years). Relapse accounted for 25% of the 333 deaths. The cumulative incidence of NRM was 22% at 5 years, and it increased over time at a projected 40% (95% confidence interval, 30%-50%) at 12 years. Centers reported that cGVHD (37.8%) was the most common cause of NRM and was associated with organ failure, infection, or additional causes not otherwise specified. The next most frequent causes without mention of cGVHD were infection (17%) and respiratory failure (10%). In multivariable analysis, an increased risk for NRM was significantly associated with the use of reduced intensity conditioning, higher total bilirubin, National Institutes of Health (NIH) skin score of 2 to 3, NIH lung score of 1 to 3, worse modified Human Activity Profile adjusted activity score, and decreased distance on walk test. To summarize, cGVHD NRM does not plateau but increases over time and is most commonly attributed to GVHD or infection, presumably associated with immunocompromised status. Severe skin and lung cGVHD remain challenging manifestations associated with increased NRM, for which novel therapeutic options that do not predispose patients to infections are needed.

A Large Cohort Comparison of 2005 National Institutes of Health Chronic Graft-Versus-Host Disease Staging Criteria to 2014 National Institutes of Health Chronic Graft-Versus-Host Disease Staging Criteria

IntroductionChronic Graft-versus-Host Disease (cGvHD) is a complication of allogeneic stem cell transplantation. 2005 NIH Staging Criteria (SC) of cGvHD emerged as result of an international effort to provide uniform standards for clinicians and researchers. In 2014, NIH cGvHD SC were revised based on gathered scientific evidence. This study assessed the impact of 2014 revision of NIH cGvHD SC on Organ and Global Score distributions, and associations to functional and quality of life measures (QOL).MethodsPatients (pts) with cGvHD participating in a natural history study of cGvHD (NCT00092235) between October 2004 and November 2016 were evaluated and followed for survival. NIH cGvHD organ and global severity scores (0-3) were prospectively assigned using the 2005 NIH cGvHD SC. Supervised by a physician experienced in cGvHD, two selected team members rescored pts retrospectively with the 2014 SC based on the original 2005 NIH cGvHD scoring forms and data obtained from assessments by clinician subspecialists. A total of 284 pts were evaluated. Distributions of organ-specific and global severity scores measured by the 2005 and 2014 NIH cGvHD SC were compared. 2014 NIH cGvHD SC were tested for associations with functional and QOL measures: Lee symptom scale (LSS), Short Form 36 (SF36), 2-minute walk test (2MW), grip strength (GS), joint range of motion (ROM), Human Activity Profile (HAP), mean Subspecialist Evaluation Score (mSSE), and Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT), using the model established by Baird et al. to validate the original 2005 NIH SC in a subset of this cohort (BBMT 2013; 19:632). Survival analysis was performed to determine potential predictors of overall survival.ResultsPts had a median age of 46 yrs (range 19-71); 37% were receiving moderate and 40% high levels of systemic immunosuppression. Pts scored by 2014 NIH SC tended to have slightly lower global severity scores in comparison to 2005 NIH SC (75% vs 72% pts with severe cGvHD). Lung and liver scores tended to be lower, 2014 NIH cGvHD organ-specific and global severity scores are shown in Table 1. 2014 NIH skin score was associated with reduced GS and ROM (both p<0.0001) and higher LSS (p=0.0001) and mSSE (p<0.0001). 2014 NIH lung score showed significant associations with lower values for 2MW, SF36 physical component summary score (PCS), and HAP maximum activity score (MAS), as well as higher mSSE (all p<0.0001) and a trend towards association with reduced GS (p=0.002). 2014 NIH global severity score (24% moderate, 72% severe in this population) was positively associated with mSSE (p<0.0001) and showed trends toward association with higher LSS and lower HAP adjusted activity score (AAS).Five-year overall survival in this cohort was 70.9% (95% CI: 64.8-76.1%) with a median potential follow-up of 79 months. The final Cox survival model included 2014 NIH Lung score (3 vs 0-2, HR=2.67, 95% CI: 1.47-4.84; p=0.0012), time from cGvHD diagnosis to consent (4+ yrs vs <4 yrs, HR=0.53, 95% CI: 0.31-0.94, p=0.028), and Karnofsky performance status (KPS, 80-100% vs <80%, HR=0.48, 95% CI: 0.30-0.77; p=0.0020). In the analysis of the 2005 NIH cGvHD SC, Baird and colleagues reported a Cox survival model including 2005 NIH lung score, time from cGvHD diagnosis to consent, and absolute eosinophil count, but not KPS.The associations between NIH Global score and the NIH lung score and patient-reported outcome measures are similar to those in the Baird et al. analysis of 2005 NIH cGvHD SC. In contrast to Baird et al. statistically significant associations are now seen between global severity, skin score and lung scores and performance-based measures including GS and 2MW. This suggests that scoring refinements introduced in 2014 have strengthened the validity of the NIH SC.ConclusionsIn this cross-sectional cohort severely affected by cGvHD, the 2014 NIH cGvHD SC organ-specific and global scores were associated with functional and QOL measures, and likely reflect cGvHD burden. Refinements in describing lung and liver cGvHD resulted in lower scores for these organs using the 2014 NIH cGvHD SC compared to the 2005 NIH cGvHD SC. These findings illustrate that 2014 NIH cGvHD SC are valid measures for cGvHD-related burden and warrant study within both clinical care and prospective trials. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Longitudinal study of physical activity with various methods in maintenance hemodialysis patients.

The purpose was to make longitudinal measurements of physical activity and study whether physical activity decreases over time in maintenance hemodialysis (MHD) patients. This was an observational study, where MHD patients were considered in a 12-month follow-up. Laboratory variables and physical activity were tested three times over 12-months in 124 hemodialysis patients. Physical activity was measured using the Human Activity Profile (HAP), the Stanford 7-day Physical Activity Recall Questionnaire (PAR), and walking speed. Repeated measure variance analysis was used to analyze changes of physical activity. The Bonferroni method was used to do pairwise comparisons. The proportion of decreased physical activity increased (P < 0.05). The maximal activity score (MAS), adjusted activity score (AAS), HAP dimension scores, and walking speed all decreased at the three time points studied (P < 0.001). At the same time, moderate physical activities and PAR values changed at three time points (P < 0.05). Pairwise comparisons showed that between the baseline and the 6-month follow-up, MAS, AAS, the scores of personal/household work, entertainment/social, independent exercise, leg effort, and back effort, all decreased(P < 0.05). Between the baseline and the 12-month follow-up, and between the 6-month follow-up and the 12-month follow-up, all the scores of HAP and walking speed decreased significantly (P < 0.001). Between the baseline and the 6-month follow-up, moderate physical activities and PAR values increased (P < 0.05). However, between the baseline and the 12-month follow-up, and between the 6-month follow-up and the 12-month follow-up, moderate physical activities and PAR did not change statistically. Physical activity decreased in hemodialysis patients in the 12-month follow-up.

Physical Activity and Quality of Life in Hemodialysis Patients and Healthy Controls: A Cross-Sectional Study.

Hemodialysis (HD) patients have lower functional abilities compared to healthy people, and this is associated with lower physical activity in everyday life. This may affect their quality of life, but research on this topic is limited. Therefore, the present study aimed to determine the relationship between habitual physical activity and quality of life in HD patients and healthy controls. Ninety-three HD patients and 140 controls participated in the study. Quality of life was assessed using a 36-item medical outcomes study short-form health survey (SF-36). Human Activity Profile (HAP) was used to assess habitual physical activity. The adjusted activity score (AAS) from HAP, age, gender, fat tissue index (FTI), lean tissue index (LTI), and Davies comorbidity score were analyzed as possible predictors of the Physical Component Summary (PCS) of the SF-36. Three sequential linear models were used to model PCS. In Model 1, PCS was regressed by gender and age; in Model 2 the LTI, FTI, and Davies comorbidity scores were added. Model 3 also included AAS. After controlling for age and gender (ModelHD 1: p = 0.056), LTI, FTI, and Davies comorbidity score effects (ModelHD 2: p = 0.181), the AAS accounted for 32% of the variation in PCS of HD patients (ModelHD 3: p < 0.001). Consequently, the PCS of HD patients would increase by 0.431 points if the AAS increased by one point. However, in healthy controls, AAS had a lower impact than in the HD sample (B = 0.359 vs. 0.431), while the corresponding effects of age and gender (ModelH 1: p < 0.001), LTI, FTI, and Davies comorbidity score (ModelH 2: p < 0.001) were adjusted for. The proportion of variation in PCS attributed to AAS was 14.9% (ModelH 3: p < 0.001). The current study results showed that physical activity in everyday life as measured by the HAP questionnaire is associated to a higher degree with the quality of life of HD patients than in healthy subjects. Routine physical activity programs are therefore highly justified, and the nephrology community should play a leading role in this effort.

Longitudinal changes in physical activity levels and fear of falling after hip fracture.

Due to global ageing, more people will suffer from hip fracture in the future, and many will be left with permanent physical impairments. The care burden for people post hip fracture is high. The aim of this study is to measure longitudinal changes in physical activity levels and fear of falling in people after hip fracture who return home after inpatient rehabilitation. Longitudinal observational study. Participants were recruited from three rehabilitation centres in Victoria, Australia. Self-reported fear of falling (Short Falls Efficacy Scale - International) and physical activity levels (Human Activity Profile - Adjusted Activity Score and Frenchay Activity Index) were assessed at 2 weeks, 3 and 6 months after discharge. Mobility (walking speed) and balance (Timed Up-and-Go test and Step Test) were measured at discharge from rehabilitation. Thirty-four participants (mean age: 82 years [SD 8]; 62% female) with unilateral hip fracture were recruited. Participants had moderately impaired balance and mobility at discharge compared to age-matched normative data; they were all discharged with a walking aid and were 40% slower in their walking speed. Participants had increased fear of falling and reduced physical activity 2 weeks after discharge, which improved significantly (p < 0.01) over the following 6 months, but scores were still lower than the normative values. At 6 months, participants also had moderate to high levels of fear of falling and were less active than the general population of similar age. Although fear of falling and physical activity improved in the 6 months following discharge, both remained negatively affected compared to normative data. Rehabilitation post hip fracture should include routine assessment of fear of falling as a potential barrier for return of physical activities.

A cross-sectional study exploring levels of physical activity and motivators and barriers towards physical activity in haemodialysis patients to inform intervention development

Purpose To describe physical activity (PA) levels and motivators and barriers to PA amongst haemodialysis (HD) patients and to identify an appropriate approach to increasing their PA. Methods A cross-sectional mixed methods study conducted in a tertiary and satellite HD unit. One hundred and one participants aged 18 years and over, receiving regular HD for at least four months, were recruited. Patients with recent hospital admission or acute cardiac event were excluded. Participants completed health status (EQ-5D-3L™) and activity (Human Activity Profile (HAP)) questionnaires. A subgroup was invited to wear accelerometers and wearable cameras to measure PA levels and capture PA episodes, to inform subsequent semi-structured interviews on motivators and barriers. Semi-structured interviews were analysed using the framework method informed by constructs of the Health Belief Model. Results 98/101 completed the study (66 males, 32 females). For 68/98 participants, adjusted activity scores from the HAP indicated “impaired” levels of PA; for 67/98 participants, the EQ-5D-3L indicated problems with mobility. Semi-structured interviews identified general (fear of falls, pain) and disease specific barriers (fatigue) to PA. Motivators included tailored exercise programmes and educational support from health care professionals. Conclusions Participants indicated a need for co-development with healthcare professionals of differentiated, targeted exercise interventions. Implications for rehabilitation Healthcare professionals should encourage and motivate haemodialysis patients to participate in physical activity (PA). As part of this approach, there is a need to increase patient knowledge of safe beneficial exercise activities and help individuals identify and overcome barriers. To allow for individualised approaches, clinical interventions should focus on other community activities that patients can do outside the dialysis clinic setting and utilise existing networks such as the British Renal Society Rehabilitation Network. The dialysis clinic provides professionals the opportunity to monitor and motivate patients. Relevant education is needed for staff about the benefits of PA and how to engage patients and their carers in safe and effective approaches.

Correction: Interaction of healthcare staff's attitude with barriers to physical activity in hemodialysis patients: A quantitative assessment.

[This corrects the article DOI: 10.1371/journal.pone.0196313.].

Interaction of healthcare staff's attitude with barriers to physical activity in hemodialysis patients: A quantitative assessment.

Background and aim of the studyIn hemodialysis patients, sedentarism is a potentially modifiable mortality risk factor. We explored whether healthcare staff’s attitude towards exercise interacts with patient-perceived barriers in modifying the level of physical activity in this population.MethodsIn this prospective, cross-sectional, multicenter study we recruited 608 adult patients and 330 members of the healthcare staff in 16 hemodialysis units in Italy. We assessed patient-perceived barriers to, and healthcare staff’s attitude towards, exercise by specific questionnaires. We fitted multilevel linear models to analyze the relationships of either barriers or staff’s attitude, and their interaction, with a measure of patient self-reported physical activity (the Human Activity Profile–Adjusted Activity Score [HAP-AAS]), adjusting for multiple confounders. We also employed latent class analysis to dichotomize patients into those endorsing or not endorsing barriers.ResultsMost barriers were negatively associated with the HAP-AAS (adjusted change attributable to a given barrier ranging between -5.1 [“Feeling too old”, 95% Confidence Interval: -9.4 to -0.8] and -15.6 [“Ulcers on legs and feet”, 95%CI: -24.8 to -6.5]. We found a significant interaction between staff’s attitude and barriers (adjusted P values ranging between 0.03 [“I do not believe that it is physician’s or nurse’s role providing advice on exercise to patients on dialysis”] and 0.001 [“I do not often ask patients about exercise”]). A beneficial effect of a proactive staff’s attitude was evident only in patients not endorsing barriers.ConclusionsBarriers and non-proactive staff’s attitude reduce physical activity in hemodialysis patients. Patients not endorsing barriers benefit the most from a proactive staff’s attitude.

Functional capacity of patients with chronic stroke based upon their physical activity levels

Introduction: People with stroke commonly show low levels of physical activity and reduced functional capacity, independent of the severity of the impairments. The use of simple measures that are able to produce transferable information from clinical practice to life in society is crucial within clinic contexts. Objective: To compare the functional capacity of patients with chronic stroke based upon their physical activity levels. Methods: For this cross sectional study, functional capacity and levels of physical activity were assessed by the Duke Activity Status Index (DASI) and the adjusted activity score (AAS) of the Human Activity Profile (HAP), respectively. One-way analysis of variance (ANOVA), followed by LSD post-hoc tests were employed to investigate differences between the physical activity groups regarding their DASI scores. Results: Fifty-one individuals with mean age 58.8 ± 13.5 and a mean time since the onset of stroke of 25.5 ± 13.9 months participated. According to their HAP AAS, 18 individuals were classified as impaired, 28 as moderately active, and five as active. Between-group differences were observed for the DASI scores [F(2,48)=13.72; p &lt; 0.01]. Conclusion: Increases in functional capacity were observed with increases in physical activity levels.Key-words: stroke, motor activity, activities of daily living.

Reference values for the bilateral heel-rise test

BackgroundThe bilateral heel-rise test is an instrument that evaluates the performance of the triceps surae. Normative parameters need to be established for the use of the heel-rise test in clinical practice. ObjectiveTo determine the reference values for the bilateral heel-rise test. MethodsThis cross-sectional study assessed healthy subjects using the bilateral heel-rise test. We analyzed the number of repetitions, time (in seconds), and repetition rate (repetitions/second) during execution of the heel-rise test, until the point of voluntary fatigue. The estimates were stratified by age and gender. Multiple linear regression was performed to define the reference equation for the bilateral heel-rise test. ResultsA total of 147 individuals were included. The median age was 37 years (IQR 28–46). It was observed that the number of repetitions decreases with age, with a higher number of repetitions in male participants compared to female participants. Gender, body mass index, and maximum activity scores predict 14% of the number of plantar flexions performed in the bilateral heel-rise test. Age and adjusted activity scores predict 18% of the repetition rate in the bilateral heel-rise test. ConclusionThe bilateral heel-rise test reference values for an adult population were defined as scores above the 25th percentile for number of repetitions, time, and repetition rate. The number of heel-rise test repetitions that corresponds to the 25th percentile, according to age and gender, is as follows: age 20–29, 65 repetitions for men and 45.5 for women; age 30–39, 62.75 men and 41.5 women; age 40–49, 67.25 men and 45 women; and age 50–59, 54 men and 39.25 women.

Physical function and 25-hydroxyvitamin D in dialysis patients - lessons learned from the Slovenian DIAGIB study.

Vitamin D stores in dialysis patients may be associated with their muscle function and physical performance. We analyzed associations of 25-hydroxyvitamin D levels with functional test results in prevalent hemodialysis patients and healthy controls. Study sample included 54 dialysis patients and 81 healthy controls who performed a 6-minute walk test, sit-to-stand test, handgrip strength measurement, and self-rated habitual adjusted activity score with Human Activity Profile questionnaire. Adjusted general linear models were used to analyze association of 25-hydroxyvitamin D levels with test results. Serum 25-hydroxyvitamin D concentration was 73.1±35.4 nmol/L in dialysis patients and 64.6±22 nmol/L in controls (p=0.12). When adjusted for age, sex, body height, spontaneous gait speed, and dialysis dependence, 25-hydroxyitamin D was significantly positively associated with 6-minute walk test result, explaining 5% of variability in walked distance (B=0.6m/nmol/L, p=0.008) and 12% of variability in adjusted activity score (B=0.1 point/nmol/L, p<0.001). There was no significant association with handgrip strength or sit-to-stand performance in adjusted models. Serum 25-hydroxyvitamin D levels are significantly positively associated with submaximal aerobic physical performance and habitual activity level in dialysis patients. .

Validade do perfil de atividade humana para estimar o consumo de oxigênio em atividades submáximas em hemiparéticos crônicos

Introduo: Instrumentos validados so necessrios para a avaliao do consumo e gasto energtico de indivduos hemiparticos. Objetivo: Investigar a validade concorrente do Perfil de Atividade Humana (PAH) com as medidas diretas de consumo de oxignio (VO2) durante atividades submximas de hemiparticos crnicos. Mtodos: Estudo transversal. O VO2 foi avaliado atravs de ergoespirmetro porttil durante a marcha mxima, habitual e subir/descer escadas. O nvel de atividade fsica foi avaliado pelo PAH, questionrio de autorrelato. Utilizou-se para a anlise o Escore Ajustado de Atividade (EAA). Resultados: 55 indivduos participaram do estudo. Observou-se existir correlao estatisticamente significativa, positiva de magnitude fraca entre o EAA do PAH e VO2 na marcha mxima (r=0,37; p=0,009), e de magnitude moderada na marcha habitual (r=0,40; p=0,004) e no teste de subir/descer escadas (r=0,43; p=0,004). Concluso: Os resultados demonstraram associao entre as medidas autorrelatadas e VO2 em atividades submximas.

Autologous stem cell transplant (ASCT) in myeloma to improve patient reported physical function and fatigue.

10044 Background: Patients with Multiple Myeloma (MM) report some of the poorest Health-related quality of life (HRQoL). Few studies show how ASCT influences global health outcomes as measured by a Geriatric Assessment (GA). We performed a prospective GA evaluating the dynamic changes in health pre- and post-ASCT. Methods: 100 pts with plasma cell dyscrasia (median (m) = 60 yrs, range (r) = 36-75 yrs) underwent GA pre-ASCT, 90 days and 1-yr post-ASCT. GA included nutritional survey, Hospital Anxiety and Depression Scale (HADS), Brief Fatigue Inventory (BFI), Medical Outcomes Study-Social Support Survey (MOS-SSS), Short Physical Performance Battery (SPPB), handgrip strength, self-reported Human Activity Profile (HAP) Maximum Activity Score (MAS) and Adjusted Activity Score (AAS). Data were analyzed using paired t-test (p &lt; 0.05). Results: Pts reported moderate fatigue pre-ASCT (m = 4.6, r: 0-9.8) which normalized at 1-yr (m = 2.5, r: 0-7.3; p = 0.008). Self-reported pre-ASCT physical function (MAS) (m = 73, r = 20-94) improved at 1-yr (m = 75.5, r = 52-94; p = 0.014); AAS (m = 64, r = 18-94) also improved at 1-yr (m = 70.5, r = 38-91; p = 0.025). In contrast, MD-reported KPS decreased. Screens for deficits in anxiety, depression, social support, objective physical function, handgrip strength and wt loss did not change significantly at 1-yr. Conclusions: Our data indicate that ASCT significantly improves patient-reported fatigue and physical function, unlike MD-reported KPS. [Table: see text]

Physical and psychosocial aspects of adolescent and young adults after allogeneic hematopoietic stem-cell transplantation: results from a prospective multicenter trial.

Allogeneic hematopoietic stem-cell transplantation (alloHSCT) is physically and psychosocially demanding. Among transplant recipients, adolescent and young adults (AYA) represent a special group, as disease occurs early in life, resulting in the prospect of long survival time and high burden of alloHSCT sequelae. However, data focusing on AYA undergoing alloHSCT are rare. Data resulting from a prospective multicenter trial initially focusing on graft-versus-host disease (GvHD) after alloHSCT were reused to analyse the differences between AYA and elderly patients. In total, data of 205 alloHSCT recipients were evaluated. Patients completed the FACT-BMT, HAP, SF-36, 24-AM, LOT-R, BSSS, HADS, and GvHD questionnaires. Median age of AYA and non-AYA patients was 29 and 52years. Using 24-AM-Test, evaluating personality traits, non-AYA reported to be more conscientious (p=0.033). However, AYA described higher quality of life regarding physical role functioning (p=0.001), physical functioning (p=0.002), bodily pain (p=0.023), and emotional role function (p=0.027) in the SF-36. General health perception, vitality, social role functioning, and mental health were comparable among both groups. On HAP scale, AYA reported higher maximum (p=0.003) and adjusted activity scores (p=0.002), but showed similar restrictions regarding activity, self-supply, and self-determination. AYA represent a particular group characterized by higher physical well-being and activity scores, and significantly vary from non-AYA patients in psychosocial aspects. Studies covering distinctive features of AYA undergoing alloHSCT are warranted to improve awareness of the special needs of this group.